Anaes Cases · Venous thromboembolism prophylaxis
Suspected spinal epidural haematoma
Short case — spinal epidural haematoma. Recognition (motor block, severe back pain, bowel or bladder dysfunction), immediate MRI, urgent surgical decompression within hours, and prevention (anticoagulant timing).
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ANZCAFRCAABAEDAIC
Prompt
Eight hours after epidural removal and LMWH restart, the postoperative patient develops dense leg weakness and severe back pain. Diagnose and manage.
Presentation
A 62-year-old woman, 8 hours after epidural catheter removal (followed by enoxaparin 40 mg given 4 hours later, per protocol), following open colorectal surgery, develops dense weakness of both legs (power 2 out of 5) and severe lower-back pain. Sensory level is at T10. She has not passed urine for 4 hours. Diagnose and manage.[1]
References1ShowHide
- [1]Kopp SL, Vandermeulen E, McBane RD, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (fifth edition) Reg Anesth Pain Med, 2025.PMID 39880411